Case-based Interactive Workshop on ICD-11 for Psychiatry Postgraduate Trainees: Our Experience

To the Editor,

In an era of advances in evaluations and interventions in the mental health field, a major development is the introduction of the much-awaited eleventh revision of the International Classification of Diseases (ICD-11). ¹ Standard diagnostic criteria not only increase the reliability of psychiatric diagnoses but also have clinical utility, such as helping the use of evidence-based treatments, helping to comply with legal requirements, and for insurance purposes. In the revamped version of ICD, chapter six deals with psychiatric disorders, and several noticeable changes have occurred. Though officially implemented in January 2022, the transition has not happened at the expected pace. We conducted workshops to familiarize the postgraduate (PG) trainees with the remodeling of the ICD structure and the noteworthy revisions in diagnostic criteria and coding in ICD-11, using a case-based approach. The specific learning objectives were: (a) to increase the awareness of changes in diagnostic criteria for various psychiatric disorders and (b) to help apply the revised diagnostic criteria to arrive at differential diagnosis and/or diagnosis of various psychiatric disorders. This would enhance their knowledge at the application level and improve their cognitive skills in diagnosing cases. The workshop format was chosen as it would include several teaching-learning strategies and provide opportunities for collaborative learning, which have been detailed later.

Workshop Format

The workshop was designed to reflect our day-to-day practice. For each of the diagnoses discussed, case vignettes based on real-life experiences were written, including information covering the essential features, a few additional features, noteworthy cultural implications, and enough details to differentiate it from normality and rule out other diagnoses. With an emphasis on interactive participation, the candidates were divided into 8–9 groups, each comprising 5–6 participants. A limit of 50 participants per workshop was set, ensuring active participation and engagement of all. Printed study material with case vignettes were given to each group. Depending on the disorder, 6–8 tasks based on the case vignette were planned, with each group receiving a different activity. The activities were designed to highlight most of the changes featured in the ICD-11 and not just limited to identifying the diagnostic criteria with the help of a checklist.

For example, the tasks for a session on “schizophrenia or other primary psychotic disorders” included essential or required features, additional clinical features, boundaries with normality, course features, developmental presentations, culture-related features, and boundaries with other disorders. The groups were given 15 min to read the vignette, discuss amongst themselves, and complete the given task. An identified representative from each group would then present their observations. This was followed by the resource person giving their input, moderating the discussion between all the groups, and clarifying the doubts. Several sessions were covered in this pattern in a day-long workshop from 9 am to 5 pm (approximately 6 h excluding breaks).

The faculty for the workshop had undergone an online training course on ICD-11 Guidelines for Mental, Behavioral, and Neurodevelopmental Disorders, conducted by the WHO Collaborating Centre for Capacity Building and Training in Global Mental Health (https://gcp.network/learning/). All faculty participated in a series of meetings to develop the content and familiarize themselves with the workshop methodology.

Feedback

To date, we have conducted three such workshops (two in Manipal, and one in Bangalore), training 128 PG students from several medical colleges and covering several blocks of ICD-11. We collected anonymous online feedback from the participants to improve the workshop to suit the needs of PGs and to explore their expectations and satisfaction with the structure and format of the workshop. Most were satisfied with the workshop format and content. Many expressed that other diagnostic categories should be covered in subsequent workshops. Other suggestions included the need for more time per session to deliver the information effectively, and incorporating games to make it more interesting. Also, based on the initial feedback in an earlier session, we incorporated multiple-choice questions in subsequent workshops to facilitate self-evaluation of knowledge.

Discussion

It is a scientifically designed and well-planned workshop incorporating evidence-based andragogic learning principles of Knowles. ² The sessions were interactive, both amongst PGs and with the resource persons. The adult learning principles such as “encourages contacts between students and faculty” and “develops reciprocity and cooperation among students” were conspicuous. The case-based learning approach adopted used authentic clinical cases to improve patient care and linked theory to practice. ³ We used the syndicate method ⁴ of teaching-learning in which the students are divided into small groups to carry out assignments in a series to accomplish a common goal; that is, different components of the disorder such as essential features, additional features, differential diagnosis, threshold, cultural issues, and so on were assigned to each group as activities under each section. It goes a step further by enhancing the ability to comprehend the knowledge and ideas presented and facilitates higher-order thinking. Also, the collaborative learning strategy of think-pair-share^5,6 was incorporated, which involves individuals thinking first by themselves, then interacting with a friend, and finally sharing with a larger group.

Thus, our objective was to familiarize the psychiatry PGs with ICD-11. We followed the workshop module, incorporating adult learning principles as detailed above, and have received encouraging feedback from participants. We wish to work on other suggestions. We have conducted this workshop in multiple settings. However, no formal assessments were done to examine the effectiveness, which is a limitation.